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* 1. Please select your postal code.

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* 2. What is your gender?

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* 3. What is your age?

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* 4. What was the purpose of your most recent visit to the health centre?

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* 5. How did you make the appointment for your most recent visit?

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* 6. Thinking about your most recent visit, how would you rate the following?

  Poor Fair Good Very Good Excellent
The length of time it took between making your appointment and the visit you had.
Your overall experience accessing the centre.
The length of time you had to wait in the reception/waiting area.
Your overall experience with health centre reception staff.
The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit.

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* 7. Thinking about the main health care provider at your most recent visit, how would you rate them on the following?

  Poor Fair Good Very Good Excellent
They knew your medical history.
They listened to your concerns.
They spoke using language that you could understand.
They were sensitive to your needs and preferences.
They treated you with dignity and respect.
They gave you clear instructions about what you need to do after your visit.
Your overall experience speaking with the health care provider about the reason for your visit.

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* 8. Thinking about your most recent visit, how would you rate the following?

  Poor Fair Good Very Good Excellent
The overall cleanliness of the centre.
The overall physical comfort of the centre.
Your confidence in the doctor/health care provider(s) you saw during the visit.
Your confidence that your health information was treated with the level of privacy you would expect.
Your overall experience with the visit you had with us.

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* 9. The last time you were sick or were concerned about your health, did you get an appointment on the date you wanted.

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* 10. The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually saw them or someone else at the centre?

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* 11. When you see your doctor or nurse practitioner, how often do they or someone else in the office do the following?

  Never Rarely Sometimes Often Always
Give you an opportunity to ask questions about recommended treatment.
Involve you as much as you want to be in decisions about your care and treatment.
Spend enough time with you.

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* 12. How long have you been coming to the Grand Bend Area Community Health Centre for your health care?

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* 13. Estimate how many times you came to the health centre in the past year or so for your own medical care.

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* 14. In the past year, which services or healthcare providers have you seen here at the centre? (Select all that apply.)

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* 15. Over the last year or so, did you receive care from a health care provider(s) at a location other than this health centre?

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